摘要
目的:比较单纯Lapidus术与Lapidus联合内侧Lisfranc内固定术治疗伴有第1跖楔关节不稳定的踇外翻畸形的中期疗效。方法:回顾性分析2019年3月至2021年3月手术治疗的伴有第1跖楔关节不稳定的踇外翻畸形患者60例(73足),其中30例(38足)采用单纯Lapidus术治疗(对照组),30例(35足)采用Lapidus联合内侧Lisfranc内固定术治疗(观察组)。术前及术后1年随访时测量并评估负重位影像学指标,包括踇外翻角(HVA),第1、2跖骨间角(IMA),胫侧籽骨位置(TSP)及第1跖骨头外侧缘“圆弧征”;记录术前及术后1年时疼痛视觉模拟评分(VAS评分)、美国足踝骨科学会评分(AOFAS评分)及跖趾关节功能评级。结果:术后1年两组患者HVA、IMA、TSP及第1跖骨头外侧缘“圆弧征”发生率均较术前有明显改善(P<0.05),AOFAS评分及疼痛VAS评分较术前明显改善(P<0.05);观察组患者HVA、IMA、TSP数值及第1跖骨头外侧缘“圆弧征”发生率明显低于对照组(P<0.05),AOFAS评分及疼痛VAS评分与对照组相比均明显改善(P<0.05)。结论:Lapidus联合内侧Lisfranc内固定术是治疗伴有第1跖楔关节不稳的踇外翻畸形的可靠手术方式。
Objective:To compare the mid-term efficacy of Lapidus surgery alone and Lapidus combined with medial Lisfranc internal fixation in patients with hallux valgus deformity combined with the first tarsometatarsal cuneiform joint(TMTJ1)instability.Methods:Sixty patients(73 feet)with moderate to severe bunions and TMTJ1 instability treated from March 2019 to March 2021 were retrospectively analyzed.Among them,the control group(30 cases,38 feet)was treated by Lapidus surgery alone,and the observation group(30 cases,35 feet)was treated with Lapidus combined with medial Lisfranc internal fixation.Weight-bearing imaging indicators were measured before surgery and one year after surgery,including hallux valgus angle(HVA),the first and second intermetatarsal angle(IMA),the position of tibial sesamoid bone(TSP),and the“arc sign”of the lateral border of the first metatarsal head.The visual analogue scale(VAS)score,American Orthopaedic Academy of Foot and Ankle(AOFAS)score,and metatarsophalangeal joint function rating were recorded before surgery and one year after surgery.Results:One year after surgery,HVA,IMA,TSP and the incidence of“arc sign”of the lateral edge of the first metatarsal bone was significantly improved,compared with that before surgery(P<0.05).And the AOFAS score and VAS score were significantly improved,compared with that before surgery(P<0.05).One year after surgery,HVA,IMA,TSP values and the incidence of“arc sign”at the lateral edge of the first metatarsal bone in the observation group were significantly lower than those in the control group(P<0.05),and AOFAS score and VAS pain score were significantly improved,compared with the control group(P<0.05).Conclusion:For patients with hallux valgus deformity combined with TMTJ1 instability,Lapidus combined with medial Lisfranc internal fixation can be a reliable surgical method.
作者
俞淮曦
蒋逸秋
YU Huaixi;JIANG Yiqiu(Department of Sports Medicine and Joint Surgery,Nanjing First Hospital,Nanjing Medical University,Nanjing 210001,China;Department of Joint Surgery,the Affiliated Huai'an Hospital of Xuzhou Medical University,the Second People's Hospital of Huai'an,Huai'an 223000,China)
出处
《东南大学学报（医学版）》
CAS
2022年第4期547-551,共5页
Journal of Southeast University(Medical Science Edition)
